System and method for treating an eye

ABSTRACT

The invention provides a device for delivering electromagnetic radiation to a limbal area of an eye that transforms one or more beams of electromagnetic radiation that are incident on a first side into one or more emitted beams of the electromagnetic radiation where the one or more beams are arrayed in a cylindrical array, an array of one or more beams each beam having a cross sectional shape of a circular arc or an array comprising a beam having an annular cross section. The invention also provides a system for delivering electromagnetic radiation to the limbal area of an eye that includes one or more devices of the invention and a source of electromagnetic radiation. The system may be used in the treatment of glaucoma.

FIELD OF THE INVENTION

This invention relates to medical devices, and in particular to suchdevices for use in ophthalmology.

BACKGROUND OF THE INVENTION

The following documents are considered to be relevant for anunderstanding of the background of the invention:

Barkana, Y and Belkin M., Selective Laser Trabeculoplasty, Survey ofOphthalmology 52:634-653, 2007.

U.S. Pat. No. 6,698,886 to Pollack et al.

U.S. Pat. No. 5,479,222 to Volk.

Under normal circumstances, aqueous humor is secreted into the posteriorchamber of the eye, and then circulates through the pupil into theanterior chamber where it passes through the trabecular meshwork, beforebeing secreted from the eye. In most forms of glaucoma, the flow of theaqueous humor through the trabecular meshwork is impeded, preventingadequate drainage of the aqueous humor from the eye. This leads to arise in the intraocular pressure, a state which may cause damage to theeye and lead to progressive blindness. One method to treat or preventthis from occurring is to alter some of the trabecular meshwork in orderto improve the flow of aqueous humor through the trabecular meshwork.

A common method of enhancing the flow of aqueous humor through thetrabecular meshwork is laser trabeculoplasty (LTP) which consists of theapplication of laser energy to the trabecular meshwork. There are aseveral types of LTP, such as selective laser trabeculoplasty (SLT)argon laser trabeculoplasty (ALT), diode laser trabeculoplasty (DLT),micropulse laser trabeculoplasty (MLT), and titanium:sapphire lasertrabeculoplasty (TLT). The various types of LTP differ in the wavelengthand other characteristics of the laser beam. SLT, for example, utilizesa Q-switched 532 Nd:YAG laser which selectively targetsmelanin-containing cells within the trabecular meshwork. (Barkana. Y etal) While the entire mechanism of action has not been completelyelucidated, it is believed that laser-stimulated melanin-containingcells release cytokines which attract other cell types to the trabecularmeshwork that increase its permeability. Unlike older versions of LTP,such as ALT, selective laser trabeculoplasty does not require precisetargeting since the wavelength and energy of the light used selectivelytargets the melanine containing cells within the meshwork. Thesurrounding cells are not heated or destroyed. Thus, the fluid outflowis improved without damaging the trabecular meshwork. SLT has been usedto treat primary open angle glaucoma, intraocular hypertension, normaltension glaucoma, aphakic (glaucoma in patients without a natural lensin their eye), pseudophakic glaucoma (glaucoma in patients without anartificial lens in their eye pigmentary, chronic angle closure glaucomaand juvenile glaucoma. SLT has also been successfully used to treatpressure increases in the eye caused by certain medications.

FIG. 1 shows the treatment of an eye 1 by LTP. Eye drops are firstplaced in the eye to provide surface anesthesia and to prepare the eyefor the procedure. The trabecular meshwork 10 is situated around theangle of the anterior chamber of the eye and is not directly observablebecause it is obscured by the limbal area 12. A gonioscopic contact lens2 which includes a mirror 3 is applied to the eye 1 to direct a laserbeam 6 through the cornea 5 to the trabecular meshwork 10 underneath thelimbal area 12. Typically, between 180° to 360° of the anterior chamberangle is irradiated by rotating the gonioscopic contact lens 12 aftereach laser pulse. About 100 laser pulses of a few nanoseconds durationand about 0.6 to 200 mJ of energy are delivered to the trabecularmeshwork.

U.S. Pat. No. 5,479,222 to Volk discloses a gonioscopic lens systemcomprising at least two lenses. At least one of the lenses includes anaspheric surface of revolution. The lenses are positioned adjacent oneanother in a housing, such that the refractive properties of each arecombined to converge light from an illumination light source to theentrance pupil of the patient's eye to illuminate the fundus. The lenssystem is designed for use with an associated ophthalmoscopic lens,enabling selective modification of the optical characteristics of theophthalmoscopic lens system in a predetermined manner.

U.S. Pat. No. 6,698,886 to Pollack et al discloses an iridotomy andtrabeculoplasty goniolaser lens having a contact lens element, a planarmirror offset from the optical axis of the contact lens element andfirst and second button lenses mounted on the anterior surface of thecontact lens element. Magnification, curvature and location of thebutton lenses are chosen so as to provide the ability to simultaneouslydeliver laser energy to the iris of a patient's eye along a firstoptical path offset from the optical axis of the contact lens elementand to view the trabecular meshwork around the region where the laserenergy was applied.

Irradiating the trabecular meshwork with a laser beam directed throughthe cornea, as shown in FIG. 1, is often not possible in cases of narrowor closed angle glaucoma which occurs when the iris of the eyeapproaches the cornea and thus narrows or eliminates the angle betweenthe cornea and the iris. This is the most common type of glaucoma inChinese and Indian people and hence the commonest form of glaucoma andblindness in the world. In these cases, the laser beam cannot reach thetrabeculum meshwork to be irradiated.

SUMMARY OF THE INVENTION

The present invention is based on the novel and unexpected finding thatLTP can be performed by irradiating the trabecular meshwork through thelimbal area, thus avoiding the need for a gonioscopic contact lens. Theinventors have found that irradiating the trabecular meshwork directlythrough the limbal area can achieve results comparable to those obtainedby prior art LTP methods that utilize a gonioscopic contact lens. Theinventors have found, for example, that a 532 nm laser beam is capableof penetrating the 1 mm thick limbal area and reaches the trabeculartissue to be treated with an adequate intensity to enhance the flow ofaqueous humor through the trabecular meshwork, and to cause asignificant decrease in intraocular pressure.

Thus, for example, in one patient suffering from open angle glaucomawith pseudoexfoliation, following irradiation of the limbal area with a532 nm Nd:YAG laser (total energy delivered to a single eye around 10J), the intraocular pressure reduced within a day from 24 to 14 mmHgwhile the patient was using antihypertensive eye drops. In anotherpatient suffering from open angle glaucoma with pseudoexfoliation, theintraocular pressure decreased from 24 mmHg to 12 mmHg a week aftertreatment with a reduction of antihypertensive eye drops from 3 to 2. Ina patient with primary open angle glaucoma the intraocular pressure wasreduced from 27 to 18 mm Hg following the treatment.

Thus, in one of its aspects, the present invention provides a device fordirecting a beam of electromagnetic radiation to one or more regions onthe limbal area of an eye. Device of the invention comprises a thinplate having one or more apertures that are arrayed in the plate tooverly locations around the limbal area. The apertures may have, forexample, a circular cross section or the apertures may have an archedshape. The plate may be rotatable so that each aperture can bepositioned over different locations of the sclerlal limbus. The devicemay be configured to be placed directly onto the eye being treated, orthe device may be configured to be held a predetermined distance awayfrom the eye.

In another of its aspects, the invention provides a system for treatingan eye. The system of the invention comprises a source ofelectromagnetic radiation, a device of the invention for directingradiation generated by the source to one or more location on the scleralimbus of an eye. The electromagnetic radiation may have, a wavelengthin the visible or near infrared range, between 514 and 810 nm, and maybe, for example, a 532 Nd:YAG laser. The system may be configured togenerated pulses of the electromagnetic radiation. In this case, thepulses may be between 0.1 to 3 nanosec in duration, and the fluence of asingle pulse may be 0.84 to 10,000 J/cm². The total energy delivered toa single eye may be from 4 to 20 J.

The invention also provides an ensemble comprising two or more devicesof the invention for delivering electromagnetic radiation to a limbalarea of an eye. In the ensemble of the invention, any two or moredevices producing a cylindrical array of emitted beams produce acylindrical array of emitted beams having a different cross-sectionaldiameter. Similarly, two or more devices producing emitted beams havinga cross sectional shape of a circular arc produces emitted beams havinga cross sectional shape of a circular arc of a different diameter. Twoor more devices producing an emitted beam having an annular crosssection produces an emitted beam having an annular cross section of oneor both of a different inner diameter or a different outer diameter.

The ensemble of the invention may be used when it is desirable toirradiate the limbal area of an eye in a procedure using a series ofirradiations of different geometrical parameters. Thus, for example, theeye may first be irradiated with a either a cylindrical array of beamsor beams having a cross sectional shape of a circular arc wherein thecylindrical array or the circular arcs have a relatively small diameter(e.g. 9 mm), and then irradiated one or more additional times, each timeincreasing the diameter. The final diameter may be around 13 mm.Similarly, the eye may be sequentially irradiated with a series of beamshaving an annular cross section where one or both of the inner diameterand the outer diameter increases each time.

In still another of its aspects, the present invention provides a methodfor treating an eye. The method of the invention comprises directingelectromagnetic radiation to one or more location on the sclera limbusof an eye. The electromagnetic radiation may have, a wavelength in thevisible or near infrared range, between 514 and 810 nm, and may begenerated, for example, by a 532 Nd:YAG laser. The electromagneticradiation may be delivered to the limbal area in pulses. In this case,the pulses may be between 0.1 to 3 nanosecond in duration, and thefluence of a single pulse may be 0.84 to 10,000 J/cm². The total energydelivered to a single eye may be from 4 to 20 J. The method of theinvention may be carried out using the system of the invention.

The invention may be used in the treatment of narrow or closed angleglaucoma, since, in accordance with the invention, the beam ofelectromagnetic radiation is not directed through the angle.

Thus, in one of its aspects, the invention provides a device fordelivering electromagnetic radiation to a limbal area of an eye, thedevice having a first side and a second side, and the devicetransforming one or more beams of electromagnetic radiation that areincident on the first side into one or more beams of the electromagneticradiation that are emitted from the second side, wherein the one or moreemitted beams are arrayed in an array selected from:

-   -   (a) an array of two or more emitted beams that are arrayed in a        cylindrical array, the cylindrical array having a circular cross        section;    -   (b) an array of one or more beams each beam having a cross        sectional shape of a circular arc; and    -   (c) an array comprising a beam having an annular cross section.

In the device of the invention, when the emitted radiation comprises twoor more emitted beams that are arrayed in a cylindrical array, thecylindrical array may have a circular cross section having a diameterfrom 9 to 13 mm. When the emitted radiation comprises an array of one ormore beams having a cross sectional shape of a circular arc; thecircular arc may have a diameter from 9 to 13 mm. When the emittedradiation comprises an array comprising a beam having an annular crosssection, the annular cross section may have an inner diameter and anouter diameter, the average of the inner diameter and the outer diameterbeing from 9 to 13 mm.

When the emitted radiation comprises two or more emitted beams that arearrayed in a cylindrical array, the device may comprise an elementopaque to the electromagnetic radiation having therein a circular arrayof apertures extending from a first face of the opaque element to asecond face of the opaque element. The circular array of apertures maycomprise, for example, at least 50 apertures. The opaque element may berotatable about the center of the circular array. When the emittedradiation comprises an array of one or more beams having a crosssectional shape of a circular arc; the device may comprise an elementopaque to the electromagnetic radiation having therein a circular arrayof apertures, each aperture having a cross sectional shape of a circulararc and each aperture extending from a first face of the opaque elementto a second face of the opaque element. The opaque element may berotatable about the center of the circular array. When the emittedradiation comprises two or more emitted beams that are arrayed in acylindrical array, the device may comprise a cylindrical array of opticfibers. The cylindrical array of optic fibers may be embedded in anopaque element, with the cylindrical array of optic fibers extendingfrom a first face of the opaque element to a second face of the opaqueclement. When the emitted radiation comprises a beam having an annularcross section, and the device may comprise a refractive or diffractiveoptical element. When the emitted radiation comprises a beam having anannular cross section, the device may comprise an ellipsoidal mirror.

The device of the invention may further comprise a concave surfaceadjacent to the second side of the device. The concave surface mayconform to the surface of the eye to promote stabilization of the deviceon an eye.

In another of its aspects, the invention provides an ensemble comprisingtwo or more devices for delivering electromagnetic radiation from thefirst source of electromagnetic radiation to a limbal area of an eye,each of the one or more devices having a first side and a second side,and each device transforming one or more beams of electromagneticradiation that are incident on the first side into one or more beams ofthe electromagnetic radiation that are emitted from the second side,wherein the one or more emitted beams are arrayed in an array selectedfrom:

-   -   (i) an array of two or more emitted beams that are arrayed in a        cylindrical array, the cylindrical array having a circular cross        section, wherein each of the one or more devices producing a        cylindrical array of emitted beams produces a cylindrical array        of emitted beams having a different cross-sectional diameter;    -   (ii) an array of one or more beams having a cross sectional        shape of a circular arc wherein each of the one or more devices        producing emitted beams having a cross sectional shape of a        circular arc produces emitted beams having a cross sectional        shape of a circular arc of a different diameter; and    -   (iii) an array comprising a beam having an annular cross        section, wherein each of the one or more devices producing an        emitted beam having an annular cross section produces an emitted        beam having an annular cross section of one or both of a        different inner diameter or a different outer diameter.

The invention also provides a system for delivering electromagneticradiation to a limbal area of an eye, comprising:

-   -   (a) a first source of electromagnetic radiation; and    -   (b) one or more devices for delivering electromagnetic radiation        from the first source of electromagnetic radiation to a limbal        area of an eye the device when the first source is optically        coupled to the device, each of the one or more devices having a        first side and a second side, and each device transforming one        or more beams of electromagnetic radiation from the first source        that are incident on the first side into one or more beams of        the electromagnetic radiation that are emitted from the second        side, wherein the one or more emitted beams are arrayed in an        array selected from:        -   (i) an array of two or more emitted beams that are arrayed            in a cylindrical array, the cylindrical array having a            circular cross section, wherein each of the one or more            devices produces a cylindrical array of emitted beams having            a different cross-sectional diameter;        -   (ii) an array of one or more beams having a cross sectional            shape of a circular arc wherein each of the one or more            devices produces emitted beams having a cross sectional            shape of a circular arc of a different diameter; and        -   (iii) an array comprising a beam having an annular cross            section, wherein each of the one or more devices produces            emitted beams having an annular cross section of a different            inner diameter or a different outer diameter.

In the system of the invention, the first source may be a laser. Thelaser may have, for example, a wavelength from 514 810 nm. The laser maybe, for example, a 532 Nd:YAG laser.

The system may further comprise a processor configured to execute apredetermined regime of activation of the first source ofelectromagnetic radiation. The predetermined regime of activation of thesource of electromagnetic radiation may comprises a series of pulses.The pulses may be between 0.1 to 3 nanoseconds in duration and thefluence of a single pulse may be from 0.84 to 10,000 J/cm2. The totalenergy delivered to a single eye may be from 4 to 20 J.

The system may further comprise a second source of electromagneticradiation that produces a visible light beam, where the second source ofradiation is configured to be optically coupled to the device of thesystem.

The invention also provides a method for delivering electromagneticradiation to a limbal area of an eye, comprising

-   -   (a) delivering electromagnetic radiation to the limbal area of        the eye wherein the delivered electromagnetic radiation is in        the form of one or more beams, the beams being arrayed in an        array selected from:        -   (i) an array of two or more emitted beams that are arrayed            in a cylindrical array, the cylindrical array having a            circular cross section;        -   (ii) an array of one or more beams having a cross sectional            shape of a circular arc; and        -   (iii) an array comprising a beam having an annular cross            section. The method may be used in the treatment of            glaucoma.

BRIEF DESCRIPTION OF DRAWINGS

In order to understand the invention and to see how it may be carriedout in practice, embodiments will now be described, by way ofnon-limiting example only, with reference to the accompanying drawings,in which:

FIG. 1 shows the beam path in SLT using a gonioscopy contact lens;

FIG. 2 shows a device for directing electric magnetic radiation to oneor more regions of a limbal area of an eye having a circular array ofapertures, in accordance with one embodiment of the invention;

FIG. 3 shows a device for directing electric magnetic radiation to oneor more regions of a limbal area of an eye having an array or arc shapedapertures, in accordance with another embodiment of the invention;

FIG. 4 shows a device for directing electric magnetic radiation to oneor more regions of a limbal area of an eye having a circular array ofapertures, where the array is rotatable;

FIG. 5 shows a a device for directing electric magnetic radiation to oneor more regions of a limbal area of an eye that includes oor more opticfibers arranged in a cylinder; and

FIG. 6 shows a system for delivering electromagnetic radiation to alimbal area of an eye in accordance with one embodiment of this aspectof the invention.

DETAILED DESCRIPTION OF EMBODIMENTS

FIG. 2 shows a device 20 for directing electric magnetic radiation toone or more regions of a limbal area of an eye in accordance with oneembodiment of the invention. The device 20 comprises a thin plate 21that may be a circular disk. The plate 2 is provided with a plurality ofsmall apertures 22 that may have a circular cross section. The plate 2is formed from an opaque material such as metal. The apertures 22 passthrough the plate 2 from an upper surface 23 to a bottom surface 25.Thus, electromagnetic radiation directed to the plate will transversethe plate only at the apertures 22. The apertures 22 are arranged in acircular array so as to overly the sclera limbus of an eye beingtreated. The circular array of apertures may have a diameter in therange from 11 to 13 mm, which is the typical diameter of the scleralimbus. The plate 21 may have as many as 200 apertures equally spacedalong the circumference of the disk 21, so that 200 spots in the scleralimbus can be treated simultaneously.

This is where the reduced-energy aiming beam comes into play. It shouldbe aimed as to cover the whole circumference of the limbus. When theoperator sees the aiming beam positioned properly, he activates thetreatment beam. See first para on page 5 above.

FIG. 3 shows a device 24 for directing electric magnetic radiation toone or more regions of a limbal area of an eye in accordance withanother embodiment of the invention. The device 24 comprises a thinplate 26 that may be a circular disk. The plate 2 is provided with aplurality of small apertures 28 having the shape of circular arcs. Theplate 26 is formed from an opaque material such as metal. The apertures28 pass through the plate 26 from an upper surface 27 to a bottomsurface 29. Thus, electromagnetic radiation directed to the plate 26will transverse the plate only at the apertures 28. The apertures 28 arearranged in a circular array so as to overly the sclera limbus of an eyebeing treated. The circular array of apertures may have a diameter inthe range from 11 to 13 mm, which is the typical diameter of the scleralimbus.

FIG. 4 shows a device 30 for directing electric magnetic radiation toone or more regions of a limbal area of an eye in accordance with yetanother embodiment of the invention. The device 30 comprises a circulardisk 32 that rotates in a circular hole in a thin plate 34. The disk 32is provided with a plurality of small apertures 36 that may have acircular cross section. The disk 32 is formed from an opaque materialsuch as metal. The apertures 36 pass through the disk 32 from an uppersurface 35 to a bottom surface. Thus, electromagnetic radiation directedto the circular disk 32 will transverse the plate only at the apertures36. The apertures 36 are arranged a long a circle to overly the scleralimbus of an eye being treated. The circular array of apertures may havea diameter in the range from 11 to 13 mm, which is the typical diameterof the sclera limbus. In use, the disk 32 may be rotated between pulsesof electric magnetic radiation to deliver the radiation to a number ofspots in the sclera limbus that is significantly greater than the numberof apertures in the disk.

FIG. 5 shows a device 40 for directing electric magnetic radiation toone or more regions of a limbal area of an eye in accordance with stillanother embodiment of the invention. The device 40 comprises a block 42of an opaque material shown in phantom drawing in FIG. 5. The block 32has a first face 44 and an oppositely situated second face 46. One ormore optic fibers 48 extend from the first face 44 to the second face46. Thus, electromagnetic radiation directed to the first face 44 willtransverse the block 42 only along the optic fibers 48. The optic fibers48 are arranged in a cylinder so that the ends of the optic fibers 48 inthe second face 46 overly the sclera limbus of an eye being treated. Thecylinder of optic fibers 48 may have a diameter in the range from 11 to13 mm, which is the typical diameter of the sclera limbus.

In another embodiment of the device of the invention, the devicecomprises a refractive or diffractive optical element. The refractive ordiffractive optical element may be made from glass or plastic havingtransmitting and refracting or diffractive optics which will create acircular beam or rapidly deliver a number of discrete beams to thelimbal area. When electromagnetic radiation is incident on therefractive or optical element, the radiation exits the opposite side ofthe element as a beam having an annular cross section. This allowsradiation of a complete circle around the limbal area by a continuousring of light. The annulus of light may have, for example, a diameterbetween 9 and 13 mm, and may be from 0.5 to 2.5 mm in radial width. Thelasers involve may be doubled Nd/YAG, argon or any diode emittingradiation in the visible or infra red

In another embodiment of the device of the invention, the optical deviceincludes an ellipsoidal or parabolic mirror that when illuminated by alarge spot of light scanning along a large circle will generate a smallring at its focal plane.

The optical device may be a lens. The lens may illuminate a single pointof the limbal area, in which case, the system may include a manipulatorto allow the laser beam to be directed to a plurality of locationsaround the limbal area in succession to impact on a plurality oflocations of the trabecular meshwork. A first point around the limbalarea can be illuminated, after which, the laser beam can be directedtowards a second point around the limbus, and so on. This can be doneautomatically and rapidly. Up to about 200 points can be illuminatedsimultaneously at the treatment intensity with a single laser.

Turning now to FIG. 6, a system 60 is shown schematically for treatingan eye in accordance with one embodiment of this aspect of theinvention. The system 60 comprises a source 62 of electromagneticradiation that generates a beam of electromagnetic radiation 64. Thesystem 60 also includes a device 66 for directing the beam 64 radiationto one or more regions of a limbal area of an eye. The device 66 may be,for example, any one of the devices 20, 24, 30 or 40 described above.Operation of the source 62 is under the control of a processing unit 68which comprises a CPU 70, a memory 72 and a user input device, such as akeypad 74.

The beam 64 can have a wavelength, for example, between 514 and 810 nm.The source 62 may be a laser in the visible or near infrared range, suchas a 532 Nd:NAG laser.

The user input device 74 may be used to input parameters relating to thetreatment. For example, a user may input a beam intensity, a number ofpulses of electromagnetic radiation that is to be delivered to the eye,and a pulse rate. The parameters may be stored in the memory 72. Thememory may also be used to store data relating to the individual beingtreated, as well as any relevant observations relating to the treatment.

The pulses may be between 0.1 to 3 nanoseconds, and the fluence of asingle pulse may be 0.84 to 10,000 J/cm². The total energy delivered toa single eye may be from 4 to 20 J. At this fluence, the beam 64 is notvisible. The system 60 may thus include a second source 76 ofelectromagnetic radiation that produces a visible light beam 78. Thesource 76 may be temporarily positioned to direct the beam 78 to thedevice 66 in order to properly position the device 66 over the eye 80 tobe treated. The device 66 is properly positioned over the eye when thebeam 64 or the beam 78 impinging on the device 66 is delivered only tothe limbal area 82 of the eye 80.

In use, the device 66 is positioned over the eye 80. As stated above,the device 66 is properly positioned over the eye when the beam 64 isdelivered only to the limbal area 82 of the eye 80. The source 62 isthen activated to generate a predetermined sequence of one or morepulses of the beam 64. At any time, the device 66 may be rotated overthe eye 80 and another sequence of one or more pulses may be generated.The process may be repeated as required in any treatment.

1-27. (canceled)
 28. A system for delivering electromagnetic radiation to a region of an eye, the system comprising: (a) at least one source of electromagnetic radiation configured for producing a treatment beam of a first electromagnetic radiation and a second aiming beam of a second electromagnetic radiation of a visual spectral range; at least one device configured for directing therethrough the first and second beams of the first and second electromagnetic radiations from said at least one source of electromagnetic radiation to one or more regions of an eye, said at least one device being configured in accordance with a circumference of a limbus or a sclera around the limbus and being manipulatable for directing the aiming visible beam onto said circumference thereby enabling visible control of the treatment beam propagation through said device to the one or more regions on said circumference, each of said at least one devices having a first side and a second side, and transforming each of the treatment and aiming beams from the first and second sources that are incident on the first side of the device into one or more beams of the respective electromagnetic radiation propagating from the second side.
 29. The system according to claim 28, wherein said one or more beams of radiation delivered to said circumference region of an eye form illumination of a ring-like annular cross section shape.
 30. The system according to claim 28, wherein the at least one device comprises an element opaque to the first and second electromagnetic radiation and having therein a circular array of spaced-apart apertures each aperture extending from a first face of the opaque element to a second face of the opaque element.
 31. The system according to claim 28, wherein said first and second beams of the electromagnetic radiations are produced by first and second radiation sources.
 32. The system according to claim 28, wherein the at least one device comprises a thin plate having one or more apertures that are arrayed in the plate to overly locations on said circumference.
 33. The system according to claim 29, wherein the ring-like annular cross section of the radiation delivered to the circumference region of an eye has an inner diameter of 9 mm and an outer diameter of 13 mm.
 34. The system according to claim 28, wherein said at least one source of electromagnetic radiation is automatically operable to direct the treatment beam through said at least one device onto the one or more regions on said circumference of the limbus or sclera around the limbus.
 35. The system according to claim 32, wherein said device has at least one of the following configurations: (a) said apertures comprises apertures having a circular cross section; (b) said apertures comprise apertures of an arced shape; and (c) said plate is configured to be rotatable so that each aperture can be positioned over different locations on said circumference.
 36. The system according to claim 28, wherein said at least one device has one of the following configurations: (1) comprises a cylindrical array of optic fibers; (2) comprises a refractive or diffractive optical element.
 37. The device according to claim 28, wherein said at least one device comprises a cylindrical array of optic fibers embedded in an opaque element and extending from a first face of the opaque element to a second face of the opaque element.
 38. The system according to claim 31, wherein the first source is a laser.
 39. The system according to claim 38, wherein the electromagnetic radiation has a wavelength in at least one of visible or near infrared range.
 40. The system according to claim 39 wherein the laser is a 532 Nd:YAG laser.
 41. The system according to claim 28 further comprising a processor configured to execute a predetermined regime of activation of the source of electromagnetic radiation to produce said first treatment beam.
 42. The system according to claim 41 wherein the predetermined regime of activation of the source of electromagnetic radiation is a pulse regime comprising generation of a series of pulses.
 43. The system according to claim 42 wherein said pulse regime provides at least one of the following: (i) the pulses are between 0.1 to 3 nanoseconds in duration; (ii) the fluence of a single pulse is from 0.84 to 10,000 J/cm²; and (iii) the total energy delivered to a single eye is from 4 to 20 J.
 44. A method for delivering electromagnetic radiation to a region of an eye, the method comprising (b) directing a first treatment beam of first electromagnetic radiation and a second aiming beam of second electromagnetic radiation of a visible spectrum towards the limbal area of the eye; (c) passing each of said first and second beams of the first and second electromagnetic radiations through a beam shaping device configured in accordance with a circumference of a limbus or a sclera around the limbus and manipulating said beam shaping device for delivering the aiming visible beam onto said circumference thereby enabling visible control of the treatment beam propagation through said device in the form of one or more beams to the one or more regions on said circumference.
 45. The method according to claim 44 for use in the treatment of glaucoma. 